Chapter 01: Concepts Basic to Perioperative Nursing
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition
MULTIPLE CHOICE
1. The Perioperative Patient Focused Model presents key components of nursing influence that
guide patient care. Select the statement that best describes the dynamic relationship within the
model.
a. The patient experience and the nursing presence are in continuous interaction.
b. Structure, process, and outcome are the foundation domains of the model.
c. The perioperative nurse is the central dynamic core of the model.
d. The interrelated nursing process rings bind the patient to the model.
ANS: A
The Perioperative Patient Focused Model consists of domains or areas of nursing concern:
nursing diagnoses, nursing interventions, and patient outcomes. These domains are in
continuous interaction with the health system that encircles the focus of perioperative nursing
practice—the patient.
2. The Association of PeriOperative Registered Nurses’ (AORN) Standards of Perioperative
Nursing describes nursing interactions, interventions, and activities with patients. This is
based on which standards category?
a. Evidence-based
b. Process
c. Outcome
d. Structural
ANS: B
Process standards relate to nursing activities, interventions, and interactions. They are used to
explicate clinical, professional, and quality objectives in perioperative nursing.
3. Which order best describes the process used to implement evidence-based professional
nursing?
a. Literature search, theory review, data analysis, policy development
b. Regional survey, literature search, meta-analysis, practice change
c. Identify problem, scientific evidence, develop policy, evaluate outcome
d. Identify issue, analyze scientific evidence, implement change, evaluate process
ANS: D
Evidence-based practice is a systematic, thorough process by which to identify an issue, to
collect and evaluate the best evidence to design and implement a practice change, and to
evaluate the process.
4. The ambulatory surgery unit is planning to develop a standardized skin preparation practice
for their unit. The best process to gather scientific information is to:
a. conduct a survey of skin prep policies at the next AORN chapter meeting.
b. review their surgical site infection data from the last 6 months.
c. conduct a literature search on antimicrobial agents and infection prevention.
d. review the scientific literature from the leading manufacturers of prep solutions.
, ANS: C
Perioperative nurses have an ethical responsibility to review practices and to modify them
based on the best available scientific evidence. Using research to guide practice is called
evidence-based practice (EBP).
5. The cardiac team is developing a standardized sterile back table setup and is unable to find
sufficient research evidence for their project. Where might they look for information on best
practices?
a. Survey regional surgical technology programs for their back table models
b. Review case studies and expert opinions on sterile back table setups
c. Review AORN’s Guidelines for Perioperative Practice on sterilization and
disinfection
d. Consult with facility instrument vendor representatives for their advice
ANS: B
When there is not enough evidence to guide practice, perioperative nurses should consider
gathering information from varied trusted sources that reflect best practices.
6. How do institutional standards of care, such as policies and procedures, differ from national
standards, such as AORN’s Standards of Perioperative Nursing?
a. They are written by nurses.
b. They are written specifically to address responsibilities under specific
circumstances.
c. They are collaborative and collective agreement statements.
d. They are rarely based on research.
ANS: B
Institutional standards apply to the system or facility that develops them and can be directive
about specific actions in specific circumstances; national standards provide generalized
authoritative statements that can be implemented in all settings.
7. Which of the following actions best describes an element of the perioperative nursing
assessment?
a. Scanning the surgical schedule for the day before morning report.
b. Reading the pick/preference list attached to the case cart.
c. Reviewing the patient medical record.
d. Studying an on-line tutorial about the intended surgical procedure.
ANS: C
Assessment is the collection and analysis of relevant health data about the patient. Sources of
data may be a preoperative interview with the patient and the patient’s family; review of the
planned surgical or invasive procedure; review of the patient’s medical record; examination of
the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit
nurses, or other personnel.
8. A frail 76-year-old diabetic woman is scheduled for major surgery. She is vulnerable and at
high risk for harm because of several factors related to her preexisting conditions and overall
health status. As part of developing a plan to guide her care, the nurse uses standardized
descriptive terms. This step of the nursing process is called:
a. nursing diagnosis.
b. nursing assessment.
, c. nursing outcome.
d. nursing intervention.
ANS: A
Nursing diagnosis is the process of identifying and classifying data collected in the
assessment in a way that provides a focus to plan nursing care. Nursing diagnosis components
include a definition of the diagnostic term, defining characteristics and risk factors.
9. During the admission interview, the nurse initiated the discharge teaching and demonstrated
crutch-walking activities. The teaching activities are what stage of the nursing process?
a. Assessment
b. Implementation
c. Outcome identification
d. Evaluation
ANS: B
Implementation is performing the nursing care activities and interventions that were planned
and responding with critical thinking and orderly action to changes in the surgical procedure,
patient condition, or emergencies. Implementation is the “work” of nursing.
10. While conducting the preoperative interview with a patient scheduled for a septoplasty, the
perioperative nurse learned that the patient was latex sensitive. Based on this knowledge, the
nurse reviewed the pick/preference list and reassembled the surgical case cart setup to reflect
this new information and change in care delivery. Which two phases of the nursing process
are represented in the nurse’s actions?
a. Assessment and planning
b. Assessment and implementation
c. Planning and implementation
d. Nursing diagnosis and intervention
ANS: C
Planning is preparing in advance for what will or may happen and determining the priorities
for care. Planning is based on patient assessment results in knowing the patient and the
patient’s unique needs. Implementation is performing the nursing care activities and
interventions that were planned and responding with critical thinking and orderly action.
Implementation is the “work” of nursing.
11. The perioperative nurse implements protective measures to prevent skin or tissue injury
caused by thermal sources. Successful accomplishment of this intervention would meet which
of the following desired nursing outcomes?
a. The patient is free from signs and symptoms of injury from anxiety.
b. The patient is free from signs and symptoms of impaired skin integrity.
c. The patient is free from signs and symptoms of surgical site infection.
d. The patient is free from signs and symptoms of hyperthermia.
ANS: B
Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g.,
electrosurgery, povidine-iodine, radiation, lasers). The patient being free from signs and
symptoms of chemical injury, radiation injury, and electrical injury are approved NANDA
International nursing diagnoses.
, 12. The nursing diagnosis is derived from:
a. patient data retrieved from the nursing assessment.
b. synthesized clues from the admitting diagnosis and surgery schedule.
c. the approved NANDA International list attached to the patient medical record.
d. the admission form on the front of the chart.
ANS: A
Nursing diagnosis is the process of identifying and classifying data collected in the
assessment in a way that provides a focus to plan nursing care.
13. A 36-year-old woman was preoperatively admitted for laparoscopic cholecystectomy with
operative cholangiogram. She was then interviewed by her perioperative nurse in the
preoperative intake lounge. The patient’s weight on admission was 245 lb. After the
assessment, the nurse returned to the operating room (OR) and modified the standard plan of
care by instituting risk reduction strategies that were derived from information from the
preoperative assessment. A good example of this action would best be described by:
a. replacing the regular OR bed with a bariatric-specific OR bed.
b. providing protective lead aprons for all staff during the procedure.
c. writing the patient’s name, allergies, and body weight on the whiteboard.
d. administering antibiotics to the patient 1 hour before the incision.
ANS: A
Planning is preparing in advance for what will or may happen and determining the priorities
for care. Planning based on patient assessment results in knowing the patient and the patient’s
unique needs so that alterations in events, such as positioning the patient on a
bariatric-specific OR bed as opposed to a regular OR bed, can be readily accommodated.
Replacing the OR bed with a larger OR bed is a nurse-sensitive preventive intervention that
provides equipment based on patient need.
14. Adoption of an electronic medical record requires the use of consistent terminology.
Empirically validated, standardized perioperative nursing language may be found in the:
a. Perioperative Patient Focused Model.
b. Nursing Alliance for Quality Care (NAQC).
c. Perioperative Nursing Data Set (PNDS).
d. Standards of Perioperative Nursing.
ANS: C
After 6 years of research and validation, the Perioperative Nursing Data Set (PNDS) was
recognized as a specialty nursing language, providing a uniform and systematic method to
document the basic elements of perioperative nursing care.
15. When delegating a task, such as removing an intravenous (IV) catheter, to an unlicensed
individual, the perioperative nurse:
a. retains responsibility for evaluating the outcome of the task.
b. must comply with the seven “rights” of delegation.
c. transfers the authority to perform the related assessments.
d. transfers the supervision of the competent person to another competent person.
ANS: C
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition
MULTIPLE CHOICE
1. The Perioperative Patient Focused Model presents key components of nursing influence that
guide patient care. Select the statement that best describes the dynamic relationship within the
model.
a. The patient experience and the nursing presence are in continuous interaction.
b. Structure, process, and outcome are the foundation domains of the model.
c. The perioperative nurse is the central dynamic core of the model.
d. The interrelated nursing process rings bind the patient to the model.
ANS: A
The Perioperative Patient Focused Model consists of domains or areas of nursing concern:
nursing diagnoses, nursing interventions, and patient outcomes. These domains are in
continuous interaction with the health system that encircles the focus of perioperative nursing
practice—the patient.
2. The Association of PeriOperative Registered Nurses’ (AORN) Standards of Perioperative
Nursing describes nursing interactions, interventions, and activities with patients. This is
based on which standards category?
a. Evidence-based
b. Process
c. Outcome
d. Structural
ANS: B
Process standards relate to nursing activities, interventions, and interactions. They are used to
explicate clinical, professional, and quality objectives in perioperative nursing.
3. Which order best describes the process used to implement evidence-based professional
nursing?
a. Literature search, theory review, data analysis, policy development
b. Regional survey, literature search, meta-analysis, practice change
c. Identify problem, scientific evidence, develop policy, evaluate outcome
d. Identify issue, analyze scientific evidence, implement change, evaluate process
ANS: D
Evidence-based practice is a systematic, thorough process by which to identify an issue, to
collect and evaluate the best evidence to design and implement a practice change, and to
evaluate the process.
4. The ambulatory surgery unit is planning to develop a standardized skin preparation practice
for their unit. The best process to gather scientific information is to:
a. conduct a survey of skin prep policies at the next AORN chapter meeting.
b. review their surgical site infection data from the last 6 months.
c. conduct a literature search on antimicrobial agents and infection prevention.
d. review the scientific literature from the leading manufacturers of prep solutions.
, ANS: C
Perioperative nurses have an ethical responsibility to review practices and to modify them
based on the best available scientific evidence. Using research to guide practice is called
evidence-based practice (EBP).
5. The cardiac team is developing a standardized sterile back table setup and is unable to find
sufficient research evidence for their project. Where might they look for information on best
practices?
a. Survey regional surgical technology programs for their back table models
b. Review case studies and expert opinions on sterile back table setups
c. Review AORN’s Guidelines for Perioperative Practice on sterilization and
disinfection
d. Consult with facility instrument vendor representatives for their advice
ANS: B
When there is not enough evidence to guide practice, perioperative nurses should consider
gathering information from varied trusted sources that reflect best practices.
6. How do institutional standards of care, such as policies and procedures, differ from national
standards, such as AORN’s Standards of Perioperative Nursing?
a. They are written by nurses.
b. They are written specifically to address responsibilities under specific
circumstances.
c. They are collaborative and collective agreement statements.
d. They are rarely based on research.
ANS: B
Institutional standards apply to the system or facility that develops them and can be directive
about specific actions in specific circumstances; national standards provide generalized
authoritative statements that can be implemented in all settings.
7. Which of the following actions best describes an element of the perioperative nursing
assessment?
a. Scanning the surgical schedule for the day before morning report.
b. Reading the pick/preference list attached to the case cart.
c. Reviewing the patient medical record.
d. Studying an on-line tutorial about the intended surgical procedure.
ANS: C
Assessment is the collection and analysis of relevant health data about the patient. Sources of
data may be a preoperative interview with the patient and the patient’s family; review of the
planned surgical or invasive procedure; review of the patient’s medical record; examination of
the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit
nurses, or other personnel.
8. A frail 76-year-old diabetic woman is scheduled for major surgery. She is vulnerable and at
high risk for harm because of several factors related to her preexisting conditions and overall
health status. As part of developing a plan to guide her care, the nurse uses standardized
descriptive terms. This step of the nursing process is called:
a. nursing diagnosis.
b. nursing assessment.
, c. nursing outcome.
d. nursing intervention.
ANS: A
Nursing diagnosis is the process of identifying and classifying data collected in the
assessment in a way that provides a focus to plan nursing care. Nursing diagnosis components
include a definition of the diagnostic term, defining characteristics and risk factors.
9. During the admission interview, the nurse initiated the discharge teaching and demonstrated
crutch-walking activities. The teaching activities are what stage of the nursing process?
a. Assessment
b. Implementation
c. Outcome identification
d. Evaluation
ANS: B
Implementation is performing the nursing care activities and interventions that were planned
and responding with critical thinking and orderly action to changes in the surgical procedure,
patient condition, or emergencies. Implementation is the “work” of nursing.
10. While conducting the preoperative interview with a patient scheduled for a septoplasty, the
perioperative nurse learned that the patient was latex sensitive. Based on this knowledge, the
nurse reviewed the pick/preference list and reassembled the surgical case cart setup to reflect
this new information and change in care delivery. Which two phases of the nursing process
are represented in the nurse’s actions?
a. Assessment and planning
b. Assessment and implementation
c. Planning and implementation
d. Nursing diagnosis and intervention
ANS: C
Planning is preparing in advance for what will or may happen and determining the priorities
for care. Planning is based on patient assessment results in knowing the patient and the
patient’s unique needs. Implementation is performing the nursing care activities and
interventions that were planned and responding with critical thinking and orderly action.
Implementation is the “work” of nursing.
11. The perioperative nurse implements protective measures to prevent skin or tissue injury
caused by thermal sources. Successful accomplishment of this intervention would meet which
of the following desired nursing outcomes?
a. The patient is free from signs and symptoms of injury from anxiety.
b. The patient is free from signs and symptoms of impaired skin integrity.
c. The patient is free from signs and symptoms of surgical site infection.
d. The patient is free from signs and symptoms of hyperthermia.
ANS: B
Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g.,
electrosurgery, povidine-iodine, radiation, lasers). The patient being free from signs and
symptoms of chemical injury, radiation injury, and electrical injury are approved NANDA
International nursing diagnoses.
, 12. The nursing diagnosis is derived from:
a. patient data retrieved from the nursing assessment.
b. synthesized clues from the admitting diagnosis and surgery schedule.
c. the approved NANDA International list attached to the patient medical record.
d. the admission form on the front of the chart.
ANS: A
Nursing diagnosis is the process of identifying and classifying data collected in the
assessment in a way that provides a focus to plan nursing care.
13. A 36-year-old woman was preoperatively admitted for laparoscopic cholecystectomy with
operative cholangiogram. She was then interviewed by her perioperative nurse in the
preoperative intake lounge. The patient’s weight on admission was 245 lb. After the
assessment, the nurse returned to the operating room (OR) and modified the standard plan of
care by instituting risk reduction strategies that were derived from information from the
preoperative assessment. A good example of this action would best be described by:
a. replacing the regular OR bed with a bariatric-specific OR bed.
b. providing protective lead aprons for all staff during the procedure.
c. writing the patient’s name, allergies, and body weight on the whiteboard.
d. administering antibiotics to the patient 1 hour before the incision.
ANS: A
Planning is preparing in advance for what will or may happen and determining the priorities
for care. Planning based on patient assessment results in knowing the patient and the patient’s
unique needs so that alterations in events, such as positioning the patient on a
bariatric-specific OR bed as opposed to a regular OR bed, can be readily accommodated.
Replacing the OR bed with a larger OR bed is a nurse-sensitive preventive intervention that
provides equipment based on patient need.
14. Adoption of an electronic medical record requires the use of consistent terminology.
Empirically validated, standardized perioperative nursing language may be found in the:
a. Perioperative Patient Focused Model.
b. Nursing Alliance for Quality Care (NAQC).
c. Perioperative Nursing Data Set (PNDS).
d. Standards of Perioperative Nursing.
ANS: C
After 6 years of research and validation, the Perioperative Nursing Data Set (PNDS) was
recognized as a specialty nursing language, providing a uniform and systematic method to
document the basic elements of perioperative nursing care.
15. When delegating a task, such as removing an intravenous (IV) catheter, to an unlicensed
individual, the perioperative nurse:
a. retains responsibility for evaluating the outcome of the task.
b. must comply with the seven “rights” of delegation.
c. transfers the authority to perform the related assessments.
d. transfers the supervision of the competent person to another competent person.
ANS: C
